Validity of the Dynamic Gait Index in People With Multiple Sclerosis.

Validity of the Dynamic Gait Index in People With Multiple Sclerosis.

Phys Ther. 2013 May 2;
Forsberg A, Andreasson M, Nilsagård YE

BACKGROUND: Evaluation of walking capacity and risk of falls in people with multiple sclerosis (PwMS) are often performed in rehabilitation. The Dynamic Gait Index (DGI) evaluates walking during different tasks, but the feasibility in identifying persons at risk of falls needs to be further investigated. OBJECTIVE: 1) investigate construct validity of the DGI: known-groups, convergent, discriminant; 2) the accuracy of predicting falls and establishing a cut-off point to identify fallers. DESIGN: A multi-centre, cross-sectional study. METHODS: A convenience sample of 81 PwMS with subjective gait and balance impairment but still able to walk 100 meters (comparable with EDSS 1-6). Mean age was 49 years, 76% were women. The 25-foot Timed Walk test, Timed Up and Go test, Four Square Step Test, Timed sit-to-stand test, MS Walking scale, Multiple Sclerosis Impact Scale (MSIS), and self-reported falls during the previous two months were used for validation, establishing cut-off point for identifying fallers and to investigate predictive values. RESULTS: Significantly lower DGI scores (p?0.001) was found for participants reporting falls (n=31). High sensitivity (87%) in identifying fallers was found with cut-off score ?19. The positive predictive value was 50% and the negative predictive value 87%. The convergent validity was moderate to strong (rho=0.58-0.80), with the highest correlation coefficient found for the 25-foot Timed Walk test. Discriminant validity was shown with low correlation for the psychological subscale of the MSIS. LIMITATIONS: The sample included ambulatory persons participating in a randomized controlled trial investigating balance training. CONCLUSIONS: The DGI is a valid measure of dynamic balance during walking for ambulatory persons with MS. With the cut-off point of ?19, sensitivity was high in identifying persons at risk of falls. HubMed – rehab


Implementation of Shared Decision Making in Physical Therapy: Observed Level of Involvement and Patient Preference.

Phys Ther. 2013 May 2;
Dierckx K, Deveugele M, Roosen P, Devisch I

BACKGROUND: Shared Decision Making (SDM) reduces the asymmetrical power between the therapist and patient. Patient involvement improves patient satisfaction, adherence and health outcomes and is a prerequisite for good clinical practice. The opportunities for using SDM in physical therapy have been considered previously. OBJECTIVE: To examine the status of SDM in physical therapy, patients’ preferred level of involvement, and the agreement between therapists’ perceptions and patients’ preferred level of involvement. DESIGN: An observational study of real consultations in physical therapy. METHODS: In total, 237 consultations, undertaken by 13 physical therapists, were audio-recorded, and 210 records were analyzed using the OPTION (Observing Patient Involvement) instrument. Before the consultation, the patient and therapist completed the Control Preference Scale. Multilevel analysis was used to study the association between individual variables and the level of SDM. Agreement on preferences was calculated using kappa-coefficients. RESULTS: The mean OPTION score was 5.2 (SD=6.8) out of a total score of 100. Female therapists achieved a higher OPTION score (b=-0.86, p=0.01). In total, 36.7% of the patients wanted to share decisions, and 36.2% preferred to give their opinion before delegating the decisions. In the majority of cases, therapists believed that they had to decide. The kappacoefficient for agreement was poor at 0.062 (95% CI, -0.018 to 0.144). LIMITATIONS: Only 13 out of 125 therapists who were personally contacted agreed to participate. CONCLUSION: SDM was not applied; although patients preferred to share decisions or at least provide their opinion about the treatment, physical therapists did not often recognize this factor. The participating physical therapists still applied a paternalistic approach and lags behind in terms of theoretical developments of decision making in health care research. HubMed – rehab


Foot Drop Stimulation Versus Ankle Foot Orthosis After Stroke: 30-Week Outcomes.

Stroke. 2013 May 2;
Kluding PM, Dunning K, O’Dell MW, Wu SS, Ginosian J, Feld J, McBride K

BACKGROUND AND PURPOSE: Drop foot after stroke may be addressed using an ankle foot orthosis (AFO) or a foot drop stimulator (FDS). The Functional Ambulation: Standard Treatment versus Electric Stimulation Therapy (FASTEST) trial was a multicenter, randomized, single-blinded trial comparing FDS and AFO for drop foot among people ?3 months after stroke with gait speed ?0.8 m/s. METHODS: Participants (n=197; 79 females and 118 males; 61.14±11.61 years of age; time after stroke 4.55±4.72 years) were randomized to 30 weeks of either FDS or a standard AFO. Eight dose-matched physical therapy sessions were provided to both groups during the first 6 weeks of the trial. RESULTS: There was significant improvement within both groups from baseline to 30 weeks in comfortable gait speed (95% confidence interval for mean change, 0.11-0.17 m/s for FDS and 0.12-0.18 m/s for AFO) and fast gait speed. However, no significant differences in gait speed were found in the between-group comparisons. Secondary outcomes (standard measures of body structure and function, activity, and participation) improved significantly in both groups, whereas user satisfaction was significantly higher in the FDS group than in the control group. CONCLUSIONS: Using either an FDS or an AFO for 30 weeks yielded clinically and statistically significant improvements in gait speed and other functional outcomes. User satisfaction was higher in the FDS group. Although both groups did receive intervention, this large clinical trial provides evidence that FDS or AFO with initial physical therapy sessions can provide a significant and clinically meaningful benefit even years after stroke.Clinical Trial Registration Information-URL: Unique Identifier: NCT01138995. HubMed – rehab


Physician Factors Affecting Cardiac Rehabilitation Referral and Patient Enrollment: A Systematic Review.

Clin Cardiol. 2013 May 3;
Ghisi GL, Polyzotis P, Oh P, Pakosh M, Grace SL

Physicians play an important role in CR referral and enrollment. Despite established benefits and recommendations, cardiac rehabilitation (CR) enrollment rates are pervasively low. The reasons cardiac patients are missing from CR programs are multifactorial and include provider factors. A number of studies have now investigated physician factors associated with referral to CR programs and patient enrollment. The objective of this study was to qualitatively and systematically review this literature. A literature search of MEDLINE, PsycINFO, CINAHL, Embase, and EBM was conducted for published articles from database inception to October 2011. Overall, 17 articles were included following a process of independent review of each article by 2 authors. Seven (41.2%) were graded as good quality according to Downs and Black criteria. There were no randomized controlled trials. Results showed that medical specialty (ie, cardiac specialists more likely to refer; n?=?8 studies) and other physician-reported reasons (eg, physician report of their reasons for CR referral and physician sex) were related to referral. Physician factors related to patient enrollment in CR were physician endorsement, medical specialty, being referred, and physician attitudes toward CR. Physician factors are consistently related to CR referral and enrollment. The role of physician endorsements in promoting patient enrollment should be optimized and exploited. HubMed – rehab